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by Barry Hermanson
Over the years, I’ve written a number of articles about the difficulty of passing universal health care legislation through the legislature in Sacramento and in Washington, D.C. Massive profits and exorbitant healthcare executive salaries drive a system that funds political campaigns and resists efforts to make fundamental change. A legislator recently commented that the piecemeal efforts to address problems in healthcare delivery were like playing whack-a-mole.
“Kaiser Family Foundation polling from March 2022 found four in ten adults (43%) report that they or a family member in their household put off or postponed needed health care due to cost.” We worry about the possibility of getting sick, receiving large medical bills and not being able to pay. More than 500,000 Americans are bankrupted by medical bills each year.
There is ample evidence in every other industrialized country that we could provide better health care to every person in the U.S. and do so for approximately half the cost per person. But the obstacles listed above are not the only thing that is keeping us from enjoying better health care.
In California, disagreements among universal healthcare advocates also keeps us from moving forward. In 2021, Assembly Bill 1400 was introduced. Written largely by the California Nurses Association (CNA), it failed to advance. It was brought back for consideration in January of 2022. It had only one month to pass the Assembly so the Senate could begin work on it. A large statewide universal healthcare coalition, Healthy California Now (HCN), waited until just a few days before the end of January to endorse it. There were portions of AB 1400 that would have harmed workers represented by the National Union of Healthcare Workers (NUHW). AB 1400 failed to advance.
This year, AB 1400 wasn’t reintroduced. Instead, a spot bill, AB 1690 (CalCare) expresses the intent to develop universal healthcare legislation with full introduction of text in January of 2024. CNA is spending the year organizing in every Assembly District in California, educating constituents and answering concerns from legislators. What they don’t appear to be doing is allowing other advocates to help in drafting the legislation. A fellow healthcare advocate comments: “CNA every single time writes the bill without input from other unions.”
She goes on to say: “Broad Labor support is a necessary influence for gaining politician support, but the CNA’s monopolization of the bill-writing process, willfully excluding the input and thus the interests and concerns of unions representing affected workers (e.g. Kaiser workers and our own SEIU medical workers such as eligibility clerks, IHSS workers, and more) keeps these Labor organizations from supporting the CNA’s bills.
“We also feel that we need a bill that attracts support from all (or almost all) Labor organizations in order to defeat any industry ballot measure to repeal or weaken any single payer bill that might be passed. Labor is not the only factor in winning cosponsors and votes, but it could be a critical one that could counterbalance industry campaign spending.”
Recently, a Healthy California Now sponsored bill was introduced, SB 770. CNA is opposing it. They sent the following message:
“Here’s why we disagree with SB 770’s approach:
“First, we already know that we will need federal waivers to fund CalCare, but legislation establishing the system must come first. There’s no point in beginning negotiations on these waivers right now. In fact, it’s legally required that a law establishing CalCare would need to pass before the federal government would even approve them.
“Second, this approach is not necessary and would add an extra bureaucratic hurdle to implementing CalCare. The Affordable Care Act already has provisions to make the establishment of a state-level single-payer system easier.
“And finally, pursuing this approach would cause unacceptable delay at a time when transitioning away from our for-profit insurance system to CalCare is more critical than ever. There are 3.2 million Californians with no insurance and millions more underinsured, and we’re still in the middle of a deadly pandemic that has taken more than 100,000 Californians from us.”
The response from Healthy California Now:
“Each of these objections is based on a false premise.
“1. SB 770 does not propose submitting a formal waiver application to the federal government for action prior to legislative approval of a comprehensive single-payer program. It would provide more direction for the work already budgeted by the Legislature so the Newsom administration can explore with the federal government the terms it might accept in a waiver for California’s use of federal healthcare dollars to create a unified healthcare financing system.
“2. SB 770 creates no hurdles to adopting a single-payer system. To the contrary, it establishes tangible steps on a concrete timeline to ensure the Newsom administration sends the Legislature a fleshed-out single-payer proposal in time to pass it and submit it for approval by the current Biden administration.
“3. CalCare has no policy content or timeline for action – it is an empty bill [Bill Text: CA AB1690 | 2023-2024 | Regular Session | Introduced] awaiting specifics to be added next year, if ever. To get from where we are to the passage of a single payer program, the Legislature needs an inclusive process, informed by the federal government’s policy and financing concerns, that yields a detailed, actionable proposal. The approach proposed by SB 770 establishes the pathway to develop the required policy and financing details while building the support necessary to achieve our shared goal: guaranteed healthcare for all Californians as soon as possible.”
Defeating powerful opponents who will spend whatever it takes to keep their profits rolling in will be very difficult. If universal healthcare advocates are not working together, it will be impossible. Politicians see that we are not together. It provides them another excuse not to act.
Although we have differences, a well known union saying should be guiding our work together:
“An injury to one is an injury to all.” Health care is a human right!
Barry Hermanson is a member of the San Francisco Green Party and a former small business owner. Contact him at Barry@Hermansons.com or 415-255-9494.
